Provider Demographics
NPI:1285910216
Name:MATSUTANI, SUSAN H (DPT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:MATSUTANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PROFESSIONAL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7902
Mailing Address - Country:US
Mailing Address - Phone:732-780-2273
Mailing Address - Fax:732-780-3752
Practice Address - Street 1:103 PROFESSIONAL VIEW DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7902
Practice Address - Country:US
Practice Address - Phone:732-780-2273
Practice Address - Fax:732-780-3752
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01422300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist